Background
Methods
Patient selection
Data Collection
Statistical analysis
Results
Characteristics of ESRD patients undergoing CGA and evaluation for kidney transplant
All N = 230 (100.0%) | High CGA rating N = 135 (58.7%) | Low CGA rating N = 95 (41.3%) | P-value† | |
---|---|---|---|---|
Age in years– mean ± SD | 68.5 ± 6.8 | 69.3 ± 6.0 | 67.4 ± 7.8 | 0.043 |
Age > 70 years– no. (%) | 116 (50.4) | 75 (55.6) | 41 (43.2) | 0.064 |
BMI in kg/m2– mean ± SD | 28.9 ± 6.6 | 28.7 ± 5.8 | 29.1 ± 7.6 | 0.691 |
Female sex– no. (%) | 108 (47.0) | 60 (44.4) | 48 (50.5) | 0.363 |
Race‡– no. (%) | ||||
Asian or Pacific Islander | 15 (6.5) | 9 (6.7) | 6 (6.3) | 0.915 |
Black | 123 (53.5) | 65 (48.1) | 58 (61.1) | 0.053 |
White | 74 (32.2) | 50 (37.0) | 24 (25.3) | 0.060 |
More than once race | 8 (3.5) | 6 (4.4) | 2 (2.1) | 0.340 |
Unknown | 10 (4.3) | 5 (3.7) | 5 (5.3) | 0.568 |
5-Factor Modified Frailty Index– mean ± SDa | 2.16 ± 1.0 | 1.78 ± 0.9 | 2.69 ± 0.9 | < 0.001 |
Comorbidities– no. (%) | ||||
Hypertension | 209 (90.9) | 124 (91.9) | 85 (89.5) | 0.643 |
Diabetes | 151 (65.7) | 82 (60.7) | 69 (72.6) | 0.062 |
Cancer | 32 (13.9) | 19 (14.1) | 13 (13.7) | 0.933 |
Congestive Heart Failure | 38 (16.5) | 13 (9.6) | 25 (26.3) | < 0.001 |
Arthritis | 44 (19.1) | 24 (17.8) | 20 (21.1) | 0.534 |
Stroke | 31 (13.5) | 12 (8.9) | 19 (20.0) | 0.015 |
Peripheral vascular or arterial disease | 11 (4.8) | 9 (6.7) | 2 (2.1) | < 0.001 |
Dementia | 4 (1.7) | 0 (0.0) | 4 (4.2) | 0.028 |
Coronary artery disease or myocardial infarction | 65 (28.3) | 31 (23.0) | 34 (35.8) | 0.033 |
Delirium | 2 (0.9) | 0 (0.0) | 2 (2.1) | 0.170 |
Prior transplant– no. (%) | ||||
Renal | 17 (7.4) | 12 (8.9) | 5 (5.3) | 0.443 |
Non-renal | 3 (1.3) | 2 (1.5) | 1 (1.1) | 1.000 |
Depression– no. (%) | 22 (9.6) | 9 (6.7) | 13 (13.7) | 0.110 |
Education– no. (%) | ||||
Less than high school | 30 (13.0) | 16 (11.9) | 14 (14.7) | 0.522 |
High school | 51 (22.8) | 30 (22.2) | 21 (22.1) | 0.983 |
College | 80 (34.8) | 47 (34.8) | 33 (34.7) | 0.990 |
Graduate | 24 (10.4) | 18 (13.3) | 6 (6.3) | 0.087 |
Unknown | 45 (19.6) | 24 (17.8) | 21 (22.1) | 0.415 |
Median income– mean ± SD | $55,907 ± $4,258 | $60,578 ± $52,785 | $49,268 ± $19,253 | 0.047 |
Social Vulnerability Indexb– mean ± SD | 0.63 ± 0.3 | 0.60 ± 0.29 | 0.66 ± 0.28 | 0.102 |
Relationship between CGA parameters, MDM decision, and overall CGA rating for kidney transplant candidacy
Assessed during CGA | All | CGA rating | P-value† | MDM decision | P-value* | ||
---|---|---|---|---|---|---|---|
N = 230 (100.0%) | High N = 135 (58.7%) | Low N = 95 (41.3%) | Listed active N = 74 (32.2%) | Deferred or not a candidate N = 156 (67.8%) | |||
Number of CGA visits– mean ± SD | 1.22 ± 0.5 | 1.24 ± 0.6 | 1.18 ± 0.5 | 0.375 | 1.36 ± 0.7 | 1.15 ± 0.5 | 0.005 |
Still driving– no. (%) | 128 (55.7) | 92 (68.1) | 36 (37.9) | < 0.001 | 51 (68.9) | 77 (49.4) | 0.005 |
Two or more falls in last year– no. (%) | 37 (16.1) | 9 (6.7) | 28 (29.5) | < 0.001 | 3 (4.1) | 34 (21.8) | < 0.001 |
Difficulty with balance– no. (%) | 85 (37.0) | 29 (21.5) | 56 (58.9) | < 0.001 | 19 (25.7) | 66 (42.3) | 0.015 |
Hospital admission in last year– no. (%) | 115 (50.0) | 54 (40.0) | 61 (64.2) | < 0.001 | 27 (36.5) | 88 (56.4) | 0.005 |
Low physical activity– no. (%) | 100 (43.5) | 30 (22.2) | 70 (73.7) | < 0.001 | 14 (18.9) | 86 (55.8) | < 0.001 |
Surgical risk– no. (%) | < 0.001 | < 0.001 | |||||
Average | 51 (22.2) | 50 (37.0) | 1 (1.1) | 27 (36.5) | 24 (15.4) | ||
Above average | 116 (50.4) | 85 (63.0) | 31 (32.6) | 47 (63.5) | 69 (44.2) | ||
Significantly increased | 56 (24.3) | 0 (0.0) | 56 (58.9) | 0 (0.0) | 56 (35.9) | ||
High | 7 (3.0) | 0 (0.0) | 7 (7.4) | 0 (0.0) | 7 (4.5) | ||
Social Support | < 0.001 | 0.005 | |||||
Adequate | 212 (92.2) | 132 (97.8) | 80 (84.2) | 73 (98.6) | 139 (89.1) | ||
Inadequate | 17 (7.4) | 2 (1.5) | 15 (15.8) | 0 (0.0) | 17 (10.9) | ||
Unknown | 1 (0.4) | 0 (0.0) | 1 (0.7) | 1 (1.4) | 0 (0.0) | ||
Control of Comorbidities‡ | < 0.001 | < 0.001 | |||||
None or well controlled | 5 (2.2) | 4 (3.0) | 1 (1.1) | 3 (4.1) | 2 (1.3) | ||
Generally well controlled | 166 (72.2) | 125 (92.6) | 41 (43.2) | 70 (94.6) | 96 (61.5) | ||
Poorly controlled | 49 (21.3) | 4 (3.0) | 45 (47.4) | 1 (1.4) | 48 (30.8) | ||
Unable to be determined | 10 (4.3) | 2 (1.5) | 8 (8.4) | 0 (0.0) | 10 (6.4) | ||
ADLsa, assistance | 0.2 ± 0.7 | 0.5 ± 0.0 | 1.0 ± 0.2 | < 0.001 | 0.0 ± 0.3 | 0.3 ± 0.8 | < 0.001 |
iADLsb– mean ± SD | |||||||
Combined | 1.9 ± 2.3 | 1.0 ± 1.7 | 3.9 ± 2.5 | < 0.001 | 0.9 ± 1.5 | 2.8 ± 2.7 | < 0.001 |
Dependency | 0.6 ± 0.5 | 0.1 ± 0.4 | 0.6 ± 1.3 | 0.001 | 0.2 ± 0.5 | 0.4 ± 1.1 | < 0.001 |
Assistance | 0.3 ± 0.9 | 0.9 ± 1.6 | 3.3 ± 2.4 | < 0.001 | 0.8 ± 1.4 | 2.4 ± 2.4 | < 0.001 |
VES-13c– mean ± SD | 2.5 ± 2.6 | 1.1 ± 1.7 | 4.5 ± 2.3 | < 0.001 | 1.0 ± 1.6 | 3.2 ± 2.7 | < 0.001 |
Medications– mean ± SD | 10.2 ± 4.7 | 9.4 ± 4.5 | 11.4 ± 4.8 | 0.003 | 10.1 ± 4.7 | 10.2 ± 4.7 | 0.661 |
History of Tobacco use– no. (%) | 91 (39.6) | 47 (34.8) | 44 (46.3) | 0.079 | 19 (25.7) | 72 (46.2) | 0.003 |
ETOH use– no. (%) | 24 (10.4) | 18 (13.3) | 6 (6.3) | 0.229 | 6 (8.1) | 15 (9.6) | 0.711 |
Health care power of attorney– no. (%) | 69 (30.0) | 41 (30.4) | 29 (21.5) | 0.885 | 24 (32.4) | 45 (28.8) | 0.536 |
Living will– no. (%) | 15 (6.5) | 13 (9.6) | 2 (2.1) | 0.028 | 7 (9.5) | 8 (5.1) | 0.259 |
Use of healthcare facilities in last year– no. (%) | |||||||
ER visit | 87 (37.8) | 38 (28.1) | 49 (51.6) | < 0.001 | 22 (29.7) | 65 (41.7) | 0.081 |
Long term care facility | 1 (0.4) | 0 (0.0) | 1 (1.1) | 0.413 | 0 (0.0) | 1 (0.6) | 1.000 |
Subacute rehab | 20 (8.7) | 4 (3.0) | 16 (16.8) | < 0.001 | 4 (5.4) | 16 (10.3) | 0.223 |
Acute rehab | 1 (0.4) | 1 (0.7) | 0 (0.0) | 1.00 | 1 (1.4) | 0 (0.0) | 0.322 |
Months on dialysis§– mean ± SD | 40.5 ± 42.2 | 39.1 ± 43.6 | 42.4 ± 40.4 | 0.607 | 44.8 ± 48.6 | 38.5 ± 38.8 | 0.351 |
Not on dialysis– no. (%) | 36 (15.7) | 26 (19.3) | 8 (8.4) | 0.023 | 15 (20.3) | 19 (12.2) | 1.000 |
MoCAd– mean ± SD | 23.9 ± 4.0 | 24.9 ± 3.5 | 22.5 ± 4.2 | < 0.001 | 25.5 ± 3.2 | 23.1 ± 4.1 | 0.061 |
Mini coge– mean ± SD | 3.6 ± 1.3 | 3.8 ± 1.3 | 3.2 ± 1.2 | 0.074 | 4.0 ± 1.3 | 3.4 ± 1.3 | 0.765 |
SPPBf– mean ± SD | |||||||
Balance | 2.8 ± 1.4 | 3.5 ± 0.9 | 1.9 ± 1.4 | < 0.001 | 3.3 ± 1.1 | 2.6 ± 1.4 | 0.003 |
Gait | 3.2 ± 1.2 | 3.9 ± 0.4 | 2.3 ± 1.5 | < 0.001 | 3.8 ± 0.5 | 3.0 ± 1.4 | < 0.001 |
Chair stands | 1.5 ± 1.3 | 2.0 ± 1.3 | 0.7 ± 1.0 | < 0.001 | 2.1 ± 1.4 | 1.2 ± 1.2 | 0.119 |
Total | 7.5 ± 3.3 | 9.3 ± 1.9 | 4.9 ± 3.1 | < 0.001 | 9.2 ± 2.2 | 6.7 ± 3.4 | < 0.001 |
Physical Frailty Phenotypeg– mean ± SD | 1.6 ± 1.3 | 0.8 ± 0.7 | 2.7 ± 1.2 | < 0.001 | 0.9 ± 0.9 | 1.9 ± 1.4 | < 0.001 |
PHQ-2h– mean ± SD | 0.3 ± 0.9 | 0.2 ± 0.7 | 0.5 ± 1.2 | 0.012 | 0.2 ± 0.5 | 0.4 ± 1.1 | 0.012 |
CGA rating of “Excellent” or “Good” | 135 (58.7) | -- | -- | -- | 70 (94.6) | 65 (41.7) | < 0.001 |
Category | Multivariable odds ratio (95% CI) | P-value |
---|---|---|
CGA Rating by Geriatrician | ||
High (“Excellent” or “Good”) | 8.46 (1.37–52.40) | 0.022 |
Low (“Borderline,” “Fair,” or “Poor”) | Reference | N/A |
Number of CGA visits | 4.93 (1.61–15.11) | 0.005 |
Age at CGA visit | 0.88 (0.79–0.98) | 0.024 |
MoCA score | 1.17 (1.01–1.35) | 0.032 |
History of tobacco use | 0.39 (0.14–1.09) | 0.072 |
High physical activity | 4.41 (1.09–17.78) | 0.037 |
Control of comorbidities | ||
Generally well controlled, well controlled, or none | 6.84 (0.59–79.03) | 0.123 |
Poorly controlled | Reference | N/A |
Two or more falls in last year | 0.00 (0.00–0.00) | 0.998 |